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Distal Interlocking for Tibial IM Nails

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strong>- Technique:/strong>br/>
    - while obtaining a perfect circle under flouroscopy it is important not to rotate the foot because this will cause a malalignment of the foot progression angle;br/>
            - instead, rotate either the entire leg as a unit or the flouro machine to achieve a perfect circle;br/>
    - drill / screw insertion may be performed in a medial to lateral or a lateral medial direction;br/>
            - advantage of lateral to medial direction is ease of insertion (because the opposite leg does not get in the way), and decreased prominence of screw head;br/>
                   - disadvantages include possible injury to the anterior tibial artery on entry (especially if nail is short) and superficial peroneal nerve;br/>
                   - note however, the ATA and SPN can be just as easily injured upon perforation of the opposite cortex from the M-L direction;br/>
            - ref: a ref="ordinalpos=13&ncbi_uid=9892122&link_uid=9892122&linksrc=docsum_title" onclick="window.open(this.href,'','resizable=no,location=no,menubar=no,scrollbars=yes,status=no,toolbar=no,fullscreen=no,dependent=no,status'); return false" href="http://www.ncbi.nlm.nih.gov/pubmed/9892122">Should distal interlocking of tibial nails be performed from a medial or a lateral direction? anatomical and biomechanical considerations./a>br/>
    - place the tip of the drill bit oblique to the X-ray beam into the stab incision and onto the tibia until the tip of the drill bit is centered in the locking hole;br/>
    - since the holes through the nail weaken it significantly, no hole must be at the fracture level or left empty if near the hole;br/>
    - references:br/>
            - a onclick="window.open(this.href,'','resizable=no,location=no,menubar=no,scrollbars=yes,status=no,toolbar=no,fullscreen=no,dependent=no,status'); return false" href="http://www.ncbi.nlm.nih.gov/pubmed/20209393">Single or double distal locking in intramedullary nailing of tibial shaft fractures: a prospective randomized study/a>br/>
            - a onclick="window.open(this.href,'','resizable=no,location=no,menubar=no,scrollbars=yes,status=no,toolbar=no,fullscreen=no,dependent=no,status'); return false" href="http://www.ncbi.nlm.nih.gov/pubmed/12003359">The effect of distal screw orientation on the intrinsic stability of a tibial intramedullary nail/a>.br/>
            - a href="http://www.ncbi.nlm.nih.gov/pubmed/23622994">How many distal bolts should be used in unreamed intramedullary nailing for diaphyseal tibial fractures/a>?br/>
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strong>- Complications:/strong>br/>
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     a href="/image3/i1/airs1.jpg">img alt="" align="middle" src="/image3/i1/airs1a.jpg"/>/a>br/>
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a onclick="window.open(this.href,'','resizable=no,location=no,menubar=no,scrollbars=yes,status=no,toolbar=no,fullscreen=no,dependent=no,status'); return false" href="http://www.ncbi.nlm.nih.gov/pubmed/7634660">Fatigue failure in small diameter tibial nails/a>.br/>
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a onclick="window.open(this.href,'','resizable=no,location=no,menubar=no,scrollbars=yes,status=no,toolbar=no,fullscreen=no,dependent=no,status'); return false" href="http://www.ncbi.nlm.nih.gov/pubmed/7634661">Mechanical failures of intramedullary tibial nails applied without reaming/a>.br/>
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a onclick="window.open(this.href,'','resizable=no,location=no,menubar=no,scrollbars=yes,status=no,toolbar=no,fullscreen=no,dependent=no,status'); return false" href="http://www.ncbi.nlm.nih.gov/pubmed/9160935">Interlocking Intramedullary Nailing with and without Reaming for the Treatment of Closed Fractures of the Tibial Shaft. A Prospective, Randomized Study/a>.br/>
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a onclick="window.open(this.href,'','resizable=no,location=no,menubar=no,scrollbars=yes,status=no,toolbar=no,fullscreen=no,dependent=no,status'); return false" href="http://www.ncbi.nlm.nih.gov/pubmed/9070520">Locking Intramedullary Nailing with and without Reaming for Open Fractures of the Tibial Shaft.  A prospective, randomized study/a>.br/>
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a onclick="window.open(this.href,'','resizable=no,location=no,menubar=no,scrollbars=yes,status=no,toolbar=no,fullscreen=no,dependent=no,status'); return false" href="http://www.ncbi.nlm.nih.gov/pubmed/15043118">Pseudoaneurysm After Tibial Nailing/a>.br/>
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a onclick="window.open(this.href,'','resizable=no,location=no,menubar=no,scrollbars=yes,status=no,toolbar=no,fullscreen=no,dependent=no,status'); return false" href="http://www.ncbi.nlm.nih.gov/pubmed/23409576">Impact of posterior tibial span class="highlight">nail/span> malpositioning on iatrogenic injuries by distal medio-lateral span class="highlight">interlocking/span> span class="highlight">screws/span>. A cadaveric study on plastinated specimens/a>.br/>/div>br/>hr/>br/>br/>br/>Last updated by Clifford R. Wheeless, III, MD on Monday, May 27, 2013 7:09 pmbr/>

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